Socio-economic factors associated with the purchasing of insecticide-treated nets in Afghanistan and their implications for social marketing

Howard, N; Chandramohan, D; Freeman, T; Shafi, A; Rafi, M; Enayatullah, S; Rowland, M; (2003) Socio-economic factors associated with the purchasing of insecticide-treated nets in Afghanistan and their implications for social marketing. Tropical medicine & international health, 8 (12). pp. 1043-1050. ISSN 1360-2276 DOI:

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Malaria is often a major health problem in war-torn countries in the tropics owing to the collapse of health services and the vulnerability of displaced populations to epidemics. Insecticide-treated nets (ITN) represent one of the few options for obtaining protection against malaria in unstable settings deficient in health infrastructure. Social marketing of subsidized ITN by a consortium of non-governmental organizations began in Afghanistan in 1993 and has continued every year since then despite regular political turmoil. Almost 350 000 nets have been sold and approximately 1.2 million people protected. In 2000 we examined the determinants of ITN purchasing among households in Nangarhar province, eastern Afghanistan, as part of an effort to increase ITN uptake. The survey was conducted using a structured questionnaire to collect data on socio-economic characteristics and malaria beliefs and practices among more than 400 net-owning and non- net-owning households. A composite socio-economic index was created using principal components analysis, and survey households were divided into socio-economic quartiles. ITN were 4.5 times more likely to be purchased by families from the richest quartile and 2.3 times more likely to be purchased from the upper-middle quartile than from the two lower quartiles. Even so, a significant minority from the lower quartiles did prioritize and buy ITN. In conflict affected countries where livelihoods are compromised, it is necessary to target subsidies at the most impoverished to make ITN affordable and to improve overall coverage.

Item Type: Article
Keywords: insecticide treated nets, social marketing, malaria, refugees, conflict, Afghanistan, complex emergencies, Malaria control, complex emergencies, impregnated bednets, top-, sheets, pakistan, chloroquine, populations, protection, attitudes, knowledge
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Health in Humanitarian Crises Centre
Social and Mathematical Epidemiology (SaME)
PubMed ID: 14641838
Web of Science ID: 186877600002


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